tsp-77

Thrift Savings Plan
TSP-77
Request for Partial
Withdrawal When Separated
February 2015

Checklist for Completing Form TSP-77,
Request for Partial Withdrawal When Separated
Be sure to read all instructions before completing this form. You can use the TSP
website (tsp.gov) to help you complete your request. You will need to log into your account
and access the program on the Withdrawals menu. It has interactive screens that
will fill in the appropriate sections of the form. Whether you use the program or not, you
must complete and submit the required pages as outlined below, and all pages that are
relevant to your request must be submitted as one package.
✓ You must complete and submit Page 1. Remember that you must sign and date the
form, and your signature must be notarized.
✓ If you are married, you must also complete and submit Page 2 (either Section VII
or VIII depending on your retirement coverage). If you are a married FERS or uniformed
services participant, your spouse must also sign the form, and the signature
must be notarized.
✓ If you have a traditional (non-Roth) balance and you would like to transfer all or a part
of the traditional (non-Roth) portion of your withdrawal, you must check the box in
Section III. You and the IRA trustee or plan administrator must complete Page 3. You
must include the completed page with your withdrawal request package.
✓ If you have a Roth balance and you would like to transfer all or a part of the Roth
portion of your withdrawal, you must check the box in Section III. You and the IRA
trustee or plan administrator must complete Page 4. You must include the completed
page with your withdrawal request package.
Note: If you would like to transfer all or a part of both the traditional and the Roth
portions of your withdrawal, you must check the box in Section III. You and the IRA
trustee or plan administrator must complete Page 3 and Page 4, even if the transfer
is to the same financial institution. You must include the completed pages with your
withdrawal request package.

THRIFT SAVINGS PLAN
REQUEST FOR PARTIAL WITHDRAWAL WHEN SEPARATED
I. INFORMATION ABOUT YOU
1. This request applies to my: Civilian Account OR Uniformed Services Account
TSP-77
2.
Last Name First Name Middle Name
3. 4. 5.
TSP Account Number
Foreign address?
6. 7.
Check here.
/ /
Date of Birth (mm/dd/yyyy)
Street Address or Box Number (For a foreign address, see instructions on back.)
Daytime Phone (Area Code and Number)
8. 9. 10.
City
Street Address Line 2
State
Zip Code
II. PARTIAL WITHDRAWAL REQUEST
11. Amount you want to withdraw: $ , , .00 (amount must be $1,000 or more)
–
III. TRANSFER ELECTION
12. I would like to transfer all or a portion of my withdrawal request to an IRA or eligible employer plan. (Note: You
must include the completed applicable transfer page(s) from this form with your withdrawal request package.)
IV. DIRECT DEPOSIT INFORMATION — This section is optional. Complete this section if you want the portion of your withdrawal
that is not being transferred (Sections IX – XII) directly deposited into your checking or savings account.
13. Type of Account: 14.
Name of Financial Institution
Checking
Savings
15. 16.
ACH Routing Number (Must be 9 digits)
Checking or Savings Account Number
V. ADDITIONAL TAX WITHHOLDING — This section is optional. If you would like more than the mandatory 20% Federal tax withholding,
complete this section. If a portion of your withdrawal is a Required Minimum Distribution, the TSP must withhold 10% of that portion.
Withholding does not apply to amounts transferred to IRAs or eligible employer plans or which are otherwise nontaxable (see instructions).
17. In addition to the mandatory 20%, withhold this amount for Federal income tax: $ , .00
VI. CERTIFICATION AND NOTARIZATION — I certify that the information I have provided on all pages of this withdrawal
request is true and complete to the best of my knowledge. If I did not complete Section VII or VIII on Page 2, I further certify
that I am an unmarried TSP participant. Warning: Any intentional false statement in this application or willful misrepresentation
concerning this request is a violation of law that is punishable by a fine or imprisonment for as long as 5 years, or both
(18 U.S.C. 1001).
18. 19.
20.
Participant’s Signature
/ /
Date Signed (mm/dd/yyyy)
Notary: Please complete the following. No other acknowledgement is acceptable (see instructions). The person
who signed Item 18 is known to or was identified by me and, before me, signed or acknowledged to have signed
this form. In witness thereof, I have signed below on this day of , .
My commission expires:
Date (mm/dd/yyyy)
Notary’s Signature
Notary’s Printed Name
Month
Year
( )
Notary’s Phone Number
* P I I S 0 0 2 3 0 1 0 0 2 0 0 0 0 0 0 0 0 P I I S *
Jurisdiction
Do Not Write Below This Line
FORM TSP-77, Page 1 (2/2015)
PREVIOUS EDITIONS OBSOLETE

FORM TSP-77, INFORMATION AND INSTRUCTIONS FOR PAGE 1
Use this form if you are separated from Federal service and you
want to request a one-time-only withdrawal of part of your vested
account balance and leave the remainder with the TSP. If you would
like to request a withdrawal of your entire vested account balance
now, do not complete this form; instead, complete Form TSP-70.
Before completing a withdrawal request, you should read the booklet
Withdrawing Your TSP Account After Leaving Federal Service and
the TSP tax notice “Important Tax Information About Payments
From Your TSP Account.” If you do not have these materials, you
can download them from the TSP website (tsp.gov) or ask your
former agency or service for a copy. You can also request them by
calling the ThriftLine.
First, make sure you are eligible for a partial withdrawal:
• Your vested account balance must be at least $1,000. Your
vested account balance is the total amount of your traditional
balance and your Roth balance (if any), less any Agency Automatic
(1%) Contributions and earnings in your account that
have not met the time-in-service requirement.
• The minimum amount for a partial withdrawal is $1,000.
• You cannot have previously made a partial withdrawal after
separating from Federal service. Only one partial withdrawal
is allowed.
• You cannot have previously made an age-based in-serv ice
withdrawal.
• You must be separated from Federal serv ice for 31 or more
days in order to be eligible for a post-employment withdrawal.
There are two ways to request a partial withdrawal:
1. Complete Form TSP-77 and mail or fax it to the TSP. Note: Your
request cannot be processed until your agency or serv ice submits
confirmation of your separation to the TSP.
or
2. Use the TSP website (tsp.gov) to begin your withdrawal request.
For security reasons, you cannot complete your request online.
You will be asked to print out your partially completed withdrawal
request form at the end of your online session. Review
the form, complete any missing information, and provide any
required signatures and documentation before you mail or fax it
to the TSP. Do not change or cross out any of the prefilled information
resulting from your entries on the Web; the form may not
be processed if you do so.
Note: This type of withdrawal cannot process until your agency or
service reports your separation to the TSP.
If you are not married and you do not want to transfer any part of
your partial withdrawal to a traditional IRA, an eligible employer
plan, or a Roth IRA, you only have to complete Page 1 of this form.
Sign the form, have it notarized, and submit it to the TSP at the address
indicated on the last page of this form.
SECTION I. Complete Items 1 – 10. Check whether you are withdrawing
money from a civilian or uniformed services account in
Item 1. Check only one box. You cannot withdraw from both accounts
using one form. Also, be sure to only check the box for the
account representing the employment from which you are separated.
If you have two TSP accounts, and you do not check a box, your
form will not be processed.
Your TSP account number is the 13-digit number that was issued
to you. The address you provide on this form will be used to update
the address in your TSP account record. If you have a foreign address,
check the box in Item 6 and enter the foreign address in
Items 7 – 10 as follows:
First address line: Enter the street address or post office box number,
and any apartment number.
Second address line: Enter the city or town name, other principal
subdivision (e.g., province, state, county), and postal code, if known.
(The postal code may precede the city or town.)
City/State/Zip Code fields: Enter the entire country name in the City
field; leave the State and Zip Code fields blank.
If you use an Air/Army Post Office (APO) or Fleet Post Office (FPO)
address, enter that address in the two available address lines (include
the unit designation). Enter APO or FPO, as appropriate, in
the City field. In the State field, enter AE as the state abbreviation
for Zip Codes beginning with 090-098, AA for Zip Codes beginning
with 340, and AP for Zip Codes beginning with 962-966. Then enter
the appropriate Zip Code.
SECTION II. You may withdraw $1,000 or more. Use a whole dollar
amount only. Note: Your withdrawal will be disbursed pro rata (i.e.,
proportionally) from any traditional (non-Roth) and Roth balances
in your account. If your vested account balance is less than $1,000,
submit a full withdrawal request using Form TSP-70.
SECTION III. Check the box in this section if you want all or a part of
the withdrawal amount you elected in Section II to be transferred to
an IRA or eligible employer plan.
To transfer all or a part of the vested, traditional (non-Roth) portion
of your withdrawal, you and the IRA trustee or plan administrator
must complete Page 3. To transfer all or any part of the Roth portion
of your withdrawal, you and the IRA trustee or plan administrator
must complete Page 4. To transfer the traditional and Roth portions
of your withdrawal, you and the IRA trustee or plan administrator
must complete Pages 3 and 4. Note: You must include the completed
applicable transfer pages with your withdrawal request package.
SECTION IV. This sectional is optional. Complete this section only
if you want the TSP to send your partial withdrawal directly to your
checking or savings account by means of a direct deposit (electronic
funds transfer (EFT)). Provide all of the requested information in
this section. If you do not know the 9-digit ACH Routing number or
your checking or savings account number, contact your financial
institution for this information. Direct deposits will be made only to
financial institutions in the United States. Note: Only the portion of
your withdrawal that is not being transferred to a traditional IRA,
eligible employer plan, or Roth IRA can be paid by EFT.
Note: If the TSP determines that the EFT information you provided
is incomplete or invalid, your request will be processed, but you will
receive your payment in the form of a check mailed to you.
SECTION V. This section is optional. Complete this section if you
want the TSP to withhold additional Federal income tax from your
withdrawal. If you do not complete this section, you will still be
subject to the mandatory 20% Federal income tax withholding on
the taxable portion of payments that you do not transfer directly
to a traditional IRA, eligible employer plan, or Roth IRA. The mandatory
withholding tax cannot be waived. If you are a uniformed
services participant with a tax-exempt balance, the tax-exempt
portion of your withdrawal will not be subject to the mandatory
20% withholding tax. Roth contributions and qualified Roth earnings
are also not subject to mandatory tax withholding. If you
complete this section requesting additional tax withholding, you
should not complete IRS Form W-4P. Read the TSP tax notice,
“Important Tax Information About Payments From Your TSP Account”
for detailed tax rules.
SECTION VI. Read the certification carefully and sign and date the
form. Your signature must be notarized; otherwise, your request
cannot be processed. Because the form will be filed with a Federal
agency in Washington, D.C., the notary must complete the notarization
in Item 20. No other acknowledgement is acceptable.
Form TSP-77 (2/2015)
PREVIOUS EDITIONS OBSOLETE

Name:
TSP Account Number:
(Last, First, Middle)
VII. MARRIED FERS AND UNIFORMED SERVICES PARTICIPANTS — Your spouse must consent to your withdrawal. Your
spouse’s signature must be notarized.
21. Spouse: By signing below, I consent to this withdrawal from my spouse’s Thrift Savings Plan ac count. I understand that
the amount withdrawn will not be available later for the purchase of a joint and survivor annuity.
Spouse’s Name (Last, First, Middle)
22. 23.
Spouse’s Signature
/ /
Date Signed (mm/dd/yyyy)
24.
Notary: Please complete the following. No other acknowledgement is acceptable (see instructions).
The person who signed Item 22 is known to or was identified by me and, before me, signed or acknowledged to have
signed this form. In witness thereof, I have signed below on this day of , .
My commission expires:
[seal]
Date (mm/dd/yyyy)
Notary’s Signature
Notary’s Printed Name
Jurisdiction
Month
Year
( )
Notary’s Phone Number
25. Participant: If you cannot obtain your spouse’s signature, provide your
spouse’s name (Item 21) and Social Security number on the right, and
submit Form TSP-16, Exception to Spousal Requirements (TSP-U-16 for
uniformed services), with the required documentation.
- -
Spouse’s Social Security Number
VIII. MARRIED CSRS PARTICIPANTS — Your spouse must be notified of your withdrawal request.
26.
Spouse’s Name (Last, First, Middle)
27. Is your spouse’s address the same as your address in your TSP record?
Yes No (Complete Items 28 – 32.)
Don’t know spouse’s address.
(Provide spouse’s SSN and submit
Form TSP-16.)
- -
Spouse’s Social Security Number
28.
Spouse has
foreign address?
29.
Check here.
Street Address or Box Number (For a foreign address, see instructions.)
Street Address Line 2
30. 31. 32.
City
State
Zip Code
–
Do Not Write Below This Line
Form TSP-77, Page 2 (2/2015)
PREVIOUS EDITIONS OBSOLETE

FORM TSP-77, INFORMATION AND INSTRUCTIONS FOR PAGE 2
Spouses’ rights apply to all partial withdrawals from your
TSP account. If you are married (even if separated from your
spouse), you must comply with the spouses’ rights requirements
outlined below:
Spouses’ Rights for Partial Withdrawals
Classification Requirement Exceptions
FERS/
Uniformed
Services
CSRS
Spouse must provide
notarized consent to the
partial withdrawal.
Spouse must be notified of
the request for a partial
withdrawal.
Whereabouts unknown
or exceptional circumstances
Whereabouts unknown
SECTION VII — Married FERS and uniformed services participants.
By law, your spouse has the right to a joint and survivor
annuity with a 50% survivor benefit, level payments, and no
cash refund, unless your spouse waives the right to that annuity.
By consenting to the partial withdrawal on this form, your
spouse acknowledges that any amount disbursed now will not
be available later for the purchase of such an annuity.
Your spouse gives consent to a partial withdrawal from your
TSP account by completing, signing, and dating Items 21 – 23.
Your spouse’s signature must be notarized (Item 24). Because
this form will be filed with a Federal agency in Washington,
D.C., the notary must complete the information in Item 24. No
other acknowledgement is acceptable.
If you cannot obtain your spouse’s signature, please provide
your spouse’s Social Security number in Item 25. The TSP
cannot process your withdrawal unless you have an exception
on file or if you apply for—and receive—an exception to
the spouses’ rights requirements. Exceptions are granted
in rare circumstances. If you wish to apply for an exception,
you can do so by submitting Form TSP-16 (TSP-U-16 for uniformed
services), Exception to Spousal Requirements, along
with this form.
SECTION VIII — Married CSRS participants. By law, the TSP
must notify your spouse of your partial withdrawal. Provide
your spouse’s name in Item 26. If your spouse’s address is
the same as your address in your TSP record, check “Yes” in
Item 27. Otherwise, check “No” in Item 27 and complete Items
28 – 32. If you do not know your spouse’s whereabouts, check
the third box in Item 27 and provide your spouse’s Social Security
number. The TSP cannot process your withdrawal unless
you have an exception on file or if you apply for—and receive—
an exception to the spouses’ rights requirements. Exceptions
are granted in rare circumstances. If you wish to apply for an
exception, you can do so by submitting Form TSP-16, Exception
to Spousal Requirements, along with this form.
If your spouse has a foreign address, check the box in Item 28
and enter the foreign address in Items 29 – 32 as follows:
First address line: Enter the street address or post office box
number, and any apartment number.
Second address line: Enter the city or town name, other principal
subdivision (e.g., province, state, county), and postal code,
if known. (The postal code may precede the city or town.)
City/State/Zip Code fields: Enter the entire country name in
the City field; leave the State and Zip Code fields blank.
If your spouse uses an Air/Army Post Office (APO) or Fleet
Post Office (FPO) address, enter that address in the two
available address lines (include the unit designation). Enter
APO or FPO, as appropriate, in the City field. In the State
field, enter AE as the state abbreviation for Zip Codes beginning
with 090-098, AA for Zip Codes beginning with 340, and
AP for Zip Codes beginning with 962-966. Then enter the appropriate
Zip Code.
Form TSP-77 (2/2015)
PREVIOUS EDITIONS OBSOLETE

Name:
TSP Account Number:
(Last, First, Middle)
TRANSFER — TRADITIONAL
You and the IRA trustee or plan administrator must complete this page if you checked the box in Item 12 and you want to
transfer all or a part of the traditional (non-Roth) portion of your withdrawal to a traditional IRA, eligible employer plan, or a
Roth IRA. Your traditional TSP balance consists of traditional contributions, tax-exempt contributions, all agency contributions,
and the earnings associated with these contributions. Note: If you choose to transfer the traditional portion of your withdrawal
to a Roth IRA, you will have to pay tax on that portion when you file your tax return for the year.
IX. YOUR TRANSFER ELECTION FOR TRADITIONAL BALANCE — After you complete this section, take or send this page
(including the instructions on the back) to your IRA or plan. Your IRA trustee or plan administrator must complete Section
X. You must submit the completed package in order for your transfer to be processed.
33. Transfer .0% of the traditional (non-Roth) portion of my withdrawal to the IRA or plan identified in
Section X. Note: You must also complete Section III on Page 1.
X. TRANSFER INFORMATION FOR TRADITIONAL BALANCE — This section is to be completed by the IRA trustee or plan
administrator. The account described here must be a traditional IRA, eligible employer plan, or a Roth IRA. Please return
this completed form to the participant. Do not submit transfer forms of financial institutions or plans.
34.
Type of Account:
Traditional IRA
Eligible Employer Plan
Roth IRA
35.
IRA/Plan Account Number or Other Customer ID
36. Check this box if tax-exempt balances are accepted into the account identified above.
37. Provide the name and mailing address information below exactly as it should appear on the front of the check.
Make check payable to
City
State
Zip Code
–
}The financial
institution
or plan will
need to use
this information
to identify the
account that
will receive
the transfer.
I confirm the accuracy of the information in this section and the identity of the individual named above. As a representative of
the fi nancial institution or plan to which the funds are being transferred, I certify that the financial institution or plan agrees to
accept the funds directly from the Thrift Savings Plan and deposit them into the IRA or eligible employer plan identified above.
38.
Typed or Printed Name of Certifying Representative (Last, First, Middle)
( )
Daytime Phone (Area Code and Number)
39. 40.
Signature of Certifying Representative
/ /
Date Signed (mm/dd/yyyy)
Do Not Write Below This Line
Form TSP-77, Page 3 (2/2015)
PREVIOUS EDITIONS OBSOLETE

FORM TSP-77, INFORMATION AND INSTRUCTIONS FOR PAGE 3
You may elect to transfer all or part of your partial withdrawal
to a traditional IRA, an eligible employer plan, or a Roth IRA.
The type of plan to which you can transfer your withdrawal
depends on whether your withdrawal consists of a traditional
(non-Roth) balance, a Roth balance, or both.
If you would like to transfer all or any part of the traditional
(non-Roth) portion of your withdrawal to an IRA or eligible
employer plan, complete Page 3.
If you would like to transfer all or any part of the Roth portion
of your withdrawal to a Roth IRA or eligible employer plan,
complete Page 4.
If you would like to transfer all or any part of both the traditional
and Roth portions of your withdrawal to separate plans
or to the same plan, you must complete Page 3 and Page 4.
SECTION IX. You may transfer all or any part of the traditional
(non-Roth) portion of your withdrawal to a traditional IRA, eligible
employer plan, or Roth IRA. Enter a percentage between
1 and 100% in Item 33. Do not enter decimals or a percentage
over 100%. If you decide to transfer to a Roth IRA, be aware
that Roth IRAs accept only after-tax dollars. As a result, you
must pay tax on the amount you transfer and the tax liability
is incurred for the year of the transfer. We strongly encourage
you to consult with a tax advisor regarding your eligibility for,
and the tax consequences of, making the transfer.
Payments that are not transferred directly to a traditional IRA,
eligible employer plan, or Roth IRA are subject to mandatory
20% Federal income tax withholding. (See Section V.) Read
the TSP tax notice “Important Tax Information About Payments
From Your TSP Account” for detailed tax rules.
SECTION X. If you choose to transfer all or any part of the
traditional (non-Roth) portion of your withdrawal to a traditional
IRA, eligible employer plan, or Roth IRA, your financial
institution or plan administrator must complete this section
before you submit this form to the TSP.
Information for the IRA or Plan: Complete Section X and
return this form to the participant identified at the top of the
page. The financial institution or plan administrator must
ensure that the account described here is a traditional IRA,
eligible employer plan, or Roth IRA.
Type of Account and Account Number. Indicate whether
the transfer is to a traditional IRA, eligible employer plan,
or Roth IRA in Item 34. In Item 35, enter the account number,
if available, of the IRA or plan to which the money is to
be transferred. If an account number is not available, provide
information that will help you identify the check when
it is sent to you.
Transfer of Tax-Exempt Balances. A uniformed services
participant may have contributed tax-exempt money from
pay earned in a combat zone to his or her traditional balance.
Check the box in Item 36 if tax-exempt balances
are accepted into the account identified in Item 34. If the
participant’s traditional balance includes tax-exempt contributions,
the taxable portion of the withdrawal from the
traditional balance will be transferred first. Tax-exempt
money will be transferred only if the taxable portion of the
withdrawal does not satisfy the participant’s transfer election
and the plan or IRA accepts tax-exempt balances. If
the plan or IRA does not accept tax-exempt balances, that
portion of the payment will be paid directly to the participant.
Name and Mailing Address. Provide the name and mailing
address information in the boxes provided exactly as you
want it to appear on the front of the transfer check. You will
need to identify the account to which the transfer should be
deposited from the information contained in these boxes.
The certifying representative must provide the requested
information in Items 38 – 40. If we need to contact the
financial institution or plan for more information, the individual
named here will be used as the contact person.
Do not submit transfer forms of financial institutions or
plans; the TSP cannot accept them.
The institution or plan to which the payment is to be transferred
must be a trust established inside the United States
(i.e., the 50 States and the District of Columbia).
The financial institution or plan should retain a copy of Page 3
to identify the account to which the check should be deposited
when it is received. If the transfer is to a traditional IRA or
Roth IRA, the institution accepting the transfer should submit
Form 5498, IRA Contribution Information, to the IRS. The TSP
will report all payments and transfers to you and to the IRS on
Form 1099-R, Distributions From Pensions, Annuities, Retirement
or Profit-Sharing Plans, IRAs, Insurance Contracts, etc.
Form TSP-77 (2/2015)
PREVIOUS EDITIONS OBSOLETE

Name:
TSP Account Number:
(Last, First, Middle)
TRANSFER — ROTH
You and the IRA trustee or plan administrator must complete this page if you checked the box in Item 12 and you want to transfer
all or a part of the Roth portion of your withdrawal to a Roth IRA or to a Roth account maintained by an eligible employer plan.
Your Roth TSP balance consists of any employee contributions that you designated as Roth when you made your contribution
election and the earnings associated with these contributions. Withdrawals of Roth contributions are paid tax-free. The earnings
associated with these contributions are paid tax-free only if 5 years have passed since January 1 of the calendar year in which you
made your first Roth contribution and you have reached age 59½ or have a permanent disability. (See instructions.)
XI. YOUR TRANSFER ELECTION FOR ROTH BALANCE — After you complete this section, take or send this page (including
the instructions on the back) to your IRA or plan. Your IRA trustee or plan administrator must complete Section XII.
You must submit the completed package in order for your transfer to be processed.
41. Transfer .0% of the Roth portion of my withdrawal to the IRA or plan identified in Section XII. Note: You
must also complete Section III on Page 1.
XII. TRANSFER INFORMATION FOR ROTH BALANCE — This section is to be completed by the IRA trustee or plan administrator.
The account described here must be a Roth IRA or a Roth account maintained by an eligible employer plan. Please
return this completed form to the participant. Do not submit transfer forms of financial institutions or plans.
42.
Type of Account:
Roth IRA
Eligible Employer Plan — Roth Account
43.
IRA/Plan Account Number or Other Customer ID
44. Provide the name and mailing address information below exactly as it should appear on the front of the check.
Make check payable to
City
State
Zip Code
–
}The financial
institution
or plan will
need to use
this information
to identify the
account that
will receive
the transfer.
I confirm the accuracy of the information in this section and the identity of the individual named above. As a representative of
the fi nancial institution or plan to which the funds are being transferred, I certify that the financial institution or plan agrees to
accept the funds directly from the Thrift Savings Plan and deposit them into the IRA or eligible employer plan identified above.
45.
Typed or Printed Name of Certifying Representative (Last, First, Middle)
( )
Daytime Phone (Area Code and Number)
46. 47.
Signature of Certifying Representative
/ /
Date Signed (mm/dd/yyyy)
Do Not Write Below This Line
Form TSP-77, Page 4 (2/2015)
PREVIOUS EDITIONS OBSOLETE

FORM TSP-77, INFORMATION AND INSTRUCTIONS FOR PAGE 4
SECTION XI. You may transfer all or any part of the Roth portion
of your withdrawal to a Roth IRA or to a Roth account
maintained by an eligible employer plan. Enter a percentage
between 1 and 100% in Item 41. Do not enter decimals or a
percentage over 100%.
Roth contributions are not subject to mandatory Federal
income tax withholding because they are not taxable upon
distribution. However, if you have not met the conditions necessary
for your Roth earnings to be qualified (i.e., paid taxfree),
any Roth earnings that are not transferred directly to a
Roth IRA or to a Roth account maintained by an eligible employer
plan are taxable and are subject to the mandatory 20%
Federal income tax withholding. Roth earnings become qualified
when the following two conditions are met: (1) 5 years
have passed since January 1 of the calendar year in which you
made your first Roth contribution and (2) You have reached
age 59½ or have a permanent disability. Note: The TSP cannot
certify to the IRS that you meet the Internal Revenue Code’s
definition of a disability when your taxes are reported. Therefore,
you must provide the justification to the IRS when you file
your taxes.
Read the TSP tax notice “Important Tax Information About
Payments From Your TSP Account” for detailed tax rules.
SECTION XII. If you choose to transfer all or any part of the
Roth portion of your withdrawal to a Roth IRA or to a Roth account
maintained by an eligible employer plan, your financial
institution or plan administrator must complete this section
before you submit this form to the TSP.
Do not submit transfer forms of financial institutions or
plans; the TSP cannot accept them.
The institution or plan to which the payment is to be transferred
must be a trust established inside the United States
(i.e., the 50 States and the District of Columbia).
The financial institution or plan should retain a copy of Page 4
to identify the account to which the check should be deposited
when it is received. If the transfer is to a Roth IRA, the institution
accepting the transfer should submit Form 5498, IRA
Contribution Information, to the IRS. The TSP will report all
payments and transfers to you and to the IRS on Form 1099-R,
Distributions From Pensions, Annuities, Retirement or Profit-
Sharing Plans, IRAs, Insurance Contracts, etc.
Information for the IRA or Plan: Complete Section XII and
return this form to the participant identified at the top of the
page. The financial institution or plan administrator must ensure
that the account described here is a Roth IRA or a Roth
account maintained by an eligible employer plan.
Type of Account and Account Number. Indicate whether
the transfer is to a Roth IRA or to a Roth account maintained
by an eligible employer plan in Item 42, and in Item
43 enter the account number, if available, of the IRA or plan
to which the money is to be transferred. If an account number
is not available, provide information that will help you
identify the check when it is sent to you.
Name and Mailing Address. Provide the name and mailing
address information in the boxes provided exactly as you
want it to appear on the front of the transfer check. You will
need to identify the account to which the transfer should be
deposited from the information contained in these boxes.
The certifying representative must provide the requested
information in Items 45 – 47. If we need to contact the financial
institution or plan for more information, the individual
named here will be used as the contact person.
PRIVACY ACT NOTICE. We are authorized to request the information you pro vide
on this form under 5 U.S.C. chapter 84, Federal Employees’ Retirement System. We
will use this information to identify your TSP account and to process your request. In
addition, this information may be shared with other Federal agencies for statistical,
auditing, or archiving purposes. We may share the information with law enforcement
agencies investigating a violation of civil or criminal law, or agencies implementing
a statute, rule, or order. It may be shared with congressional offices, private sector
audit firms, spouses, former spouses, and beneficiaries, and their attorneys. We
may disclose relevant portions of the information to appropriate parties engaged in
litigation and for other routine uses as specified in the Federal Register. You are not
required by law to provide this information, but if you do not provide it, we will not be
able to process your request.
Form TSP-77 (2/2015)
PREVIOUS EDITIONS OBSOLETE

After completing your withdrawal request, make a copy for your records.
Mail the original to:
Thrift Savings Plan
P.O. Box 385021
Birmingham, AL 35238
Or fax to: 1-866-817-5023.
Note: Do not mail and fax your request. The TSP will automatically cancel the second
request it receives. If you need to make a change or correction on your form, call the
TSP to cancel your first request. If the TSP has processed your form prior to receiving
your call, your transaction cannot be reversed.
If you have questions, call the toll-free ThriftLine at 1-TSP-YOU-FRST (1-877-968-3778)
or the TDD at 1-TSP-THRIFT5 (1-877-847-4385). Outside the U.S. and Canada, please
call 404-233-4400 (not toll free).

Form TSP-77 (2/2015)
PREVIOUS EDITIONS OBSOLETE